ProSeal Laryngeal Mask Airway Insertion Research Articles

Erişkin Hastalarda Laringeal Maske Hava Yolu Pozisyonunun Doğrulanmasında Ultrasonografinin Rolü

Objective: The study aims to evaluate the Proseal laryngeal mask airway (PLMA) position with ultrasonographic imaging. Methods: The study included American Society of Anesthesiologists I-III patients with Mallampati scores I-II and operated using PLMA as an airway device. Before PLMA insertion, the glottic aperture was assessed by ultrasonography (USG). After PLMA placement, the USG evaluation was repeated. The symmetry of the arytenoid cartilages was examined. Asymmetry of an arytenoid to the glottic midline and the other arytenoid was graded 0 to 3 (USG arytenoid grade). After PLMA was placed, fiber optic bronchoscopy (FOB) was done to evaluate the PLMA position (FOB LMA grade). The relationship between USG arytenoid grade and FOB LMA grade was examined. Results: Forty-eight patients were included in the study. The mean age was 49 ± 15.8 (19-82), and 25 were female. It was determined that PLMA was in the correct position in 81.3% of the evaluation with USG and 68.8% of the assessment with FOB. USG arytenoid grade correlated with FOB LMA grade (r= -.582, p<.001). To detect a rotated LMA, USG had a sensitivity of 100% (%95 CI, 39.8 – 100.0) and a specificity of %80 (%95 CI, 22.8 – 99.8). The positive and negative predictive values were %97.7 (%95 CI, 88.0 – 99.9) and %100 (%95 CI, 91.8 – 100.0), respectively. The accuracy was %97.9 (%95 CI, 86.3 – 99.3). Conclusion: Ultrasonografi can be a simple, noninvasive, and reliable method to confirm PLMA placement in anesthesia practice. Keywords: Laryngeal mask airway, ultrasonography, airway management

Usefulness of bougie-preloaded proseal laryngeal mask airway versus digital insertion technique in correct placement of the device.

Digital technique of proseal laryngeal mask airway (PLMA) insertion carries high chance of failed first attempt successful placement. We aimed to compare the number of attempts taken for correct placement of bougie-preloaded PLMA versus traditional digital insertion technique. Ease of insertion, time taken, hemodynamic responses during insertion, and evidence of trauma were also assessed. This prospective, randomized, open-label study was performed in 60 patients. All patients were administered general anesthesia according to a standardized protocol.After induction of general anesthesia in group P, proseal insertion was performed following the traditional digital technique. In group B, bougie-preloaded PLMA was used. A soft gum elastic bougie was passed through the gastric channel of PLMA, with 15cm protruding distally through the gastric port. Attempts at successful insertion and ease of insertion were noted. Time taken for successful insertion was significantly shorter in group B compared to group P (15.3 ± 4.5 vs. 57 ± 12.02 s, respectively). The first attempt success in group B was 90% versus 60% in group P. The number of moderate to hard insertion was significantly lesser in group B (10 vs. 40, respectively). Blood stain on device was seen in 3.3% in group B compared to 30% in group P. MAP at insertion and at 1, 3, and 5 min was significantly higher in group P. Heart rates were comparable. Bougie-preloaded proseal insertion has significantly higher first attempt insertion success rates and is significantly faster and less traumatic with blunted blood pressure response compared to traditional digital insertion technique.

A Comparison of Dexmedetomidine and Fentanyl as Co-induction Agents to Propofol for Insertion of Proseal Laryngeal Mask Airway: A Randomised Clinical Study

Introduction: The Supraglottic Airway Devices (SAD) are bridges between a face mask and Endotracheal Tubes (ETT). Various induction agents like sevoflurane and propofol were used till date for smooth insertion. Propofol causes dose-dependent cardio-respiratory depression while opioids may increase the haemodynamic instability. Aim: To investigate the role of dexmedetomidine and fentanyl as co-induction agents to propofol for Proseal Laryngeal Mask Airway (PLMA) insertion conditions. Materials and Methods: The present study was a randomised clinical study in which 60 patients of American Society of Anaesthesiologists (ASA) grade I-II, 20-60 years of age were divided into two groups. Group P+D received 2.5 mg/kg propofol + 1 µg/kg dexmedetomidine while Group P+F received 2.5 mg/ kg propofol + 1 µg/kg fentanyl. A Bispectral Index (BIS) value of 50-45 was taken as desired end point for insertion of PLMA. Induction time, insertion time, ease of insertion, number of attempts, total propofol requirement and various hemodynamic changes were taken into consideration. Results: Mean induction time with dexmedetomidine (8.28±0.81min) was lower as compared to that with fentanyl (9.28±0.83 min) (p<0.0001). Total propofol requirement was also less with dexmedetomidine (93.66±15.64 mg) as compared to that with fentanyl (135.8±10.95 mg). Dexmedetomidine also provided better insertion score for PLMA (p=0.044) with less number of attempts (p=0.044), when compared with fentanyl. Conclusion: Dexmedetomidine, as an adjuvant to propofol can be considered as an attractive choice for insertion of PLMA.

Evaluation of gum elastic bougie guided Proseal laryngeal mask airway insertion technique

Introduction: Endotracheal Intubation (ETI) is highest quality level for airway organization. LMA ProSeal™ (PLMA) insertion utilizing Gum Elastic Bougie (GEB) guidance, which has got 100% first attempt success rate, also requires laryngoscopy, hence nullifying its advantage of being a supraglottic airway device. We aimed to compare the hemodynamic responses associated with laryngoscopy assisted GEB guided PLMA placement with that of conventional endotracheal intubation. Method: Hundred normotensive ASA1 or 2 patients of either sex (age 18 to 40yrs) undergoing general anesthesia for elective surgery included and evaluated for pressor response. Following a uniform premedication and standard anesthesia technique (thiopentone + vecuronium), either of airway was placed and pulse rate, (beats/min); Mean blood pressure, MAP (mmHg) (at Tb = base line, T0 = just before laryngoscopy and PLMA/ETT placement, T1 = 1min, T3 = 3min, T5 = 5 min, T7 = 7 min after placement). Results: Patients demographics between the PLMA and ETT groups were similar. Following laryngoscopy and PLMA\ETT placement, both were associated with statistically significant increase in HR and MAP with respect to its basal value. Although it was less marked in case of PLMA Group, when comparison was made within individual Group. Duration of laryngoscopy and time of placement were longer in PLMA Group as compared to ETT Group (35.71 and 12.69 sec. vs 21.30 and 10.76 sec. respectively). ETT insertion was related with higher incidence of cough (p 0.05). Conclusion: Hence GEB guided PLMA method must be used as a reinforcement method in cases where standard insertion methods fall ineffective and in ineffectual tracheal intubation where the bougie is incidentally embedded into throat and quick control of the airway route is essential. Key words: Gum elastic bougie; Laryngeal Mask Airway; Hemodynamics; Pressor response Abbreviations: LMA – laryngeal mask airway; ETI – Endotracheal Intubation; GEB – Gum Elastic Bougie; ETT –Endotracheal tube; PLMA – Laryngeal Mask Airway ProSeal Citation: Upadhyay MK, Kumar G, Chaurasia A, Narang D. Evaluation of gum elastic bougie guided Proseal laryngeal mask airway insertion technique. Anaesth. pain intensive care 2021;25(3):338–344. DOI: doi.org/10.35975/apic.v25i3.1531 Received: March 20, 2021; Reviewed: April 11, 2021; Accepted: May 11, 2021

Ease of ProSeal laryngeal mask airway insertion in children (after placement) using suction catheter: A comparison with conventional techniques

Objectives: The ProSeal Laryngeal Mask Airway (PLMA) mostly inserted by finger technique and by an introducer tool method. Recently a newer Suction Catheter Guided (SC) insertion technique has been successfully used in children. We performed a study in children with aims and objective to compare the ease of PLMA insertion using SC and conventional techniques. Methods: 126 American Society of Anaesthesiologist’s class I and II children in age group of 1-12 years weighing 10-50 kg, admitted in our hospital, undergoing an elective surgery in under general anaesthesia in supine position were included in our study. An appropriate size PLMA was inserted using Suction Catheter, introducer tool or digital technique in Groups SC, I and D respectively (n=42) after induction of general anaesthesia. Correct placement of the PLMA was confirmed by using appropriate clinical tests. Ease of PLMA insertion with hemodynamic response was done by time to insertion, number of insertion attempts to achieve effective ventilation and number of cases which required lateral approach of insertion. Results: In Group SC, PLMA device was inserted after a single attempt in 41 (97.6%) patients, but PLMA insertion was failed in 5 patients in Group I (11.9%) and 6 patients in Group D (14.3%) even after two attempts, and the difference was statistically significant (p=0.044). Time taken for successful placement was statistically shorter in the SC-guided group (SC 22.5±4.021 seconds, I 31.4± 17.57 seconds, D 27.10±12.9 seconds, p value Conclusion: Suction Catheter guided ProSeal LMA insertion was an easier, faster, more successful and a relatively atraumatic technique which also ensures correct placement of the PLMA in the hypopharynx as compared to the routine conventional PLMA insertion techniques with no hemodynamic pressor response to PLMA insertion using any of the three techniques. Keywords: ProSeal LMA, Suction Catheter insertion.

A Comparative Study of the Proseal Laryngeal Mask Airway (PLMA) Insertion by Three Different Technique I.E. Introducer, Digital and Stylet

Background: Supraglottic airway devices have been widely used as an alternative to tracheal intubation during general anesthesia. Proseal Laryngeal Mask Airway (PLMA) is an effective alternative to ETT with inflatable cuff forming pressure seal around laryngeal inlet and permitting ventilation. In view of this, the present study was undertaken to compare the different insertion techniques to insert PLMA in adult patients undergoing elective surgeries. Methodology: Ninety patients scheduled for elective surgical procedures under general anesthesia belonging to ASA grade I and II were included in the study and were randomly divided into three groups with 30 patients in each group. In Group I (n=30), PLMA was inserted using introducer, in Group II (n=30) PLMA was inserted using digit and in group III (n=30) PLMA was inserted using stylet. Groups were compared in relation to number of attempts, insertion time, ease of insertion, orogastric tube insertion and, hemodynamic changes. Results: The success first attempt rate for placement of PLMA was highest with introducer as compared to digit or stylet and the results were statistically significant (p=0.029). The mean time of insertion for PLMA using introducer was 27.03±4.08 seconds which was shortest whereas with digit it was highest 35.27±4.97 (p=0.000) and by using stylet 31.33±3.12 seconds. There was no change in hemodynamic after the insertion of PLMA with either technique. Conclusion: To conclude introducer technique of PLMA insertion was best as compared to digit and stylet technique.

Dexmedetomidine with propofol versus fentanyl with propofol for insertion of Proseal laryngeal mask airway: A randomized, double-blinded clinical trial

Background and Aims:Successful insertion of the proseal laryngeal mask airway (PLMA) requires much greater doses of propofol as compared to classic laryngeal mask (CLMA). Dexmedetomidine and fentanyl are equally effective adjuvants for CLMA insertion. We designed this study to compare the efficacy of these two drugs as sole adjuvant in PLMA insertion.Material and Methods:Seventy four American Society of Anesthesiologists (ASA) I and II patients were randomly allocated to receive either dexmedetomidine 1 μg/kg [Group PD] or fentanyl 1 μg/kg [Group PF]. Study drugs were diluted in 10 ml NS and administered over 10 min prior to induction of anesthesia with 2.5 mg/kg propofol. PLMA insertion condition was measured according to the Muzi scoring system. Score ≤2 was considered optimal for PLMA insertion. Patient's cardio-respiratory parameters, emergence time, and postoperative pain were also recorded.Results:In our study 83.8% patients in the group PF and 91.9% in the group PD achieved optimal insertion condition (not significant). Hemodynamic stability was maintained in both the groups but the incidence of apnea was significantly higher in the PF group (P = 0.011). We also observed that emergence time was prolonged but postoperative pain scores were significantly lower in the PD group (P < 0.001).Conclusion:We conclude that both dexmedetomidine and fentanyl in a dose of 1 μg/kg when used before induction with propofol provide comparable conditions for successful PLMA insertion. Dexmedetomidine has additional advantage of preserving spontaneous respiration and providing better analgesia.

Comparison of Two Supraglottic Airway Devices: I-gel Airway and ProSeal Laryngeal Mask Airway Following Digital Insertion in Nonparalyzed Anesthetized Patients.

Aims:The study is aimed to compare the efficacy of I-gel and ProSeal laryngeal mask airway (PLMA) in nonparalysed anesthetized individuals following manufacturer-recommended digital insertion.Materials and Methods:In this prospective randomized observational study, 40 American Society of Anesthesiologists I and II patients, aged 18–65 years scheduled for elective surgical procedures were allocated either to PLMA group (Group P, n = 20) or the I-gel group (Group I, n = 20). Following digital insertion of PLMA or I-gel, the following parameters were compared: insertion time, ease of insertion, number of attempts, failed insertion, airway reaction during insertion, oropharyngeal leak (OPL) pressure, and gastric insufflation on auscultation. Fiberoptic view of both the channels of the airway devices and ease of insertion of 12 F Ryle's tube through gastric drain channel were graded. Postoperative complications were also noted.Results:First attempt and overall insertion success were similar (PLMA, 85% and 100%; I-gel 80% and 100%, respectively). Mean (standard deviation) insertion times were similar (PLMA, 27.40 [11.51] s; I-gel 25.45 [9.03] s). Mean OPL pressure was 3.5 cm H2O higher with PLMA (P < 0.012). The passage of Ryle's tube was easier through I-gel than PLMA. Grade I glottic view (full view of the vocal cords) was visible in 17 (85%) patients who were managed with I-gel whereas only 9 (45%) patients had Grade I view in the PLMA group.Conclusion:The time required for digital insertion of PLMA and I-gel in nonparalyzed anesthetized patients is similar but PLMA forms a better oropharyngeal seal. I-gel is better positioned over the laryngeal framework and esophagus. I-gel allows easier passage of Ryle's tube through its drain channel than PLMA. The incidence and severity of postoperative sore throat and hoarseness was higher with PLMA.

Endotracheal Tube and Proseal Laryngeal Mask Airway in Elderly Hypertensive Diabetic Patients Undergoing Routine Laparoscopic Surgical Procedures: A Comparison of Hemodynamic Parameters

Background: The effects of ProSeal laryngeal mask airway (PLMA) removal and tracheal extubationon cardiovascular responses were studied in elderly hypertensive diabetic patients in a randomize double-blind study.Methods: A total of 60 elderly controlled diabetic hypertensive American Society of Anesthesiologists II &amp; III patients were randomly allocated to two groups (n-30 of each) for PLMA insertion or endotracheal intubation. A standardized anesthetic sequence was used for induction and maintenance of anesthesia. The two groups were then compared for haemodynamic changes at the time of extubation/PLMA removal.Results: In PLMA group, heart rate increased during PLMA removal but remained elevated for only 3 minutes while mean arterial pressure remained elevated for only 2 minutes.The elevations of heart rate and mean arterial pressure were exaggerated in the extubation group and persisted for more than 5 minutes. No complication was observed in any patient and no difficulty was encountered in insertion of PLMA in any patient.Conclusion: Elderly hypertensive diabetic patients are at risk of exaggerated pressor response at the time of extubation. PLMA removal is associated with fewer hemodynamic changes than tracheal extubation and should be preferred wherever possible.J Bangladesh Coll Phys Surg 2018; 36(4): 153-158

Prospective randomized study comparing the standard weight-based method and a novel method based on combined width of index, middle and ring fingers for ProSeal laryngeal mask airway size selection in paediatric patients

Introduction : Appropriate size selection of ProSeal laryngeal mask airway (PLMA) is an important prerequisite for successful use of the device. Size of PLMA is often selected based on weight of patients. We aimed to determine whether combined width of patient’s index, middle and ring fingers could be used as an alternative to weight based selection of appropriate size of PLMA. Materials and methods : In this prospective randomized study, 102 patients aged 6 months to 10 years were included. Patients were allocated to one of two groups based on a randomization table and PLMA inserted according to the group allocated. In Group S, PLMA size selected according to weight based method whereas in Group N, PLMA size was selected based on 3-finger breadth of patients. We recorded insertion parameters, fiberoptic scoring of glottic visualisation, airway manipulations and postoperative complications. Results : In 68 children (66.66%) size of PLMA was same according to both methods. The kappa coefficient was 0.461 concluding moderate agreement between two methods. In the remaining 34 children (33.34%), the disagreement in sizes were with only one size, in whom the patient’s weights were borderline values. The PLMA insertion time, ease of insertion, insertion attempts, fiberoptic view of position of device were comparable in both groups. There were no significant complications in the postoperative period. Conclusion : Three finger breadth sizing method can be used as a good alternative to weight-based method for selecting appropriate size of PLMA in children.

Pressure responses following the insertion of pro-seal laryngeal mask airway in patients with controlled hypertension: A comparison with tracheal intubation

Aims &amp; Objectives: To compare:1) Hemodynamic responses during insertion of pro-seal laryngeal mask airway (PLMA) vs endo-tracheal tubation (ETT) in hypertensive patients under control. 2) The incidence of complications.&#x0D; Methods: A total of 30 patients aged between 45-60 years of ASA grade II having history of essential hypertension under control, were on oral medication who were posted for abdominal surgeries under GA were randomly divided into two groups of 15 each (One group for PLMA insertion and other for ETT insertion). The two groups were compared for pressor responses following insertion of PLMA or ETT.&#x0D; Results: After PLMA Insertion, mean pulse increased from 67±7 to 68±5 per minute, Systolic Blood Pressure (BP) increased from 123±1 to 127±5 per mmHg, Diastolic BP increased from 72±8 to 78±7 per mmHg and Mean Artery Pressure (MAP) increased from 89±11 to 94±8 mm Hg. After ETT insertion: Mean pulse increased from 68±2 to 80±8 per minute, Systolic BP increased from 124±1 to 152±8 per mmHg, Diastolic BP increased from 72±8 to 96±8 per mmHg and MAP increased from 89±10 to 115±4 mm Hg.&#x0D; Conclusion: We concluded that Proseal LMA is safe. It is judged by: Stable hemodynamics, adequate oxygenation, and ventilation and less complications.

A study to compare digital technique and suction catheter guided technique for insertion of proseal laryngeal mask airway in children

Objectives: The present study was conducted to compare digital technique and suction catheter guided technique for Proseal laryngeal mask airway insertion regarding ease of insertion, number of attempts for successful insertion and insertion time in children. Methods: This prospective randomised study included one hundred children of age 1-12 years divided into two groups. In group I, Proseal laryngeal mask airway insertion was inserted using digital technique and in group II, suction catheter guided technique was used for insertion. Results: In group I, Proseal laryngeal mask airway insertion was successfully inserted in 45 patients (90%), while in group II, insertion was successful in 49 patients (98%). Insertion was successful in 37 patients (74%) in first attempt and 8 patients (16%) required 2nd attempt in group I, whereas in group II, 1st attempt was successful in 47 patients (94%) and 2nd attempt was required in 2 patients (4%). Proseal laryngeal mask airway insertion failed in 5 patients (10%) in group I while it failed in only 1 patient (2%) in group II. Mean insertion time was 23.88 ± 2.58 sec in group I, whereas in group II, time was 19.34 ± 1.81 sec (p=0.001), the difference being statistically significant. Conclusion: Suction catheter guided technique is easier and more successful as compared to digital technique in children. It is less traumatic and insertion time is also less with this technique.

A comparison of metal introducer and bougie-guided techniques of insertion PLMATM with respect to cuff position and air leak

Background: Drain tube is an integral part of proseal laryngeal mask airway (PLMA). It can lodge a sleek device such as bougie which can act as a guiding tool to advance and position the cuff. As an alternative to metal introducer tool (MIT), we compared the two techniques for ease of insertion score, various cuff positions and air leak encountered during insertion of PLMA under nonparalysed situation. Materials and Methods: Sixty anesthetized patients were divided into two groups using computer-based randomization. PLMA was inserted into either MIT or adult introducer bougie. The primary outcome was ease of insertion (Score 1–4), cuff positions defined by suprasternal notch test, gel displacement test, gastric tube passage test and air leak. Airway pressure, seal pressure, and complications encountered were the secondary outcome. Independent t-test, Fisher's exact test, and Chi-square test were used to analyze the data. P

A modified tongue depressor facilitates the insertion of ProSeal laryngeal mask airway: Comparison with digital and introducer techniques

BackgroundThe larger and softer cuff of the ProSeal laryngeal mask airway (LMA) may cause difficulty in insertion. We introduced a novel technique using a modified tongue depressor to aid the ProSeal LMA insertion. MethodsA total of 150 patients were randomly allocated into three groups of 50 each, digital (D), introducer (I), and tongue depressor (TD). The ProSeal LMA was inserted by the aid of digit, introducer and a modified tongue depressor, respectively. The primary outcomes included insertion time, insertion frequency, pre- and post-insertion blood pressure/heart rate, presence of blood on the ProSeal LMA cuff after removal, and postoperative sore throat. ResultsThe insertion time was significantly shorter in the TD group than in the D and I groups (23.3 ± 5.1 s vs. 26.8 ± 9.3 s and 27.8 ± 9.5 s; p = 0.025 and p = 0.004). The rate of successful intubation on the first attempt was significantly higher in the TD group than in the D and I groups (98% vs. 84% and 82%; p = 0.035 and p = 0.02). The incidence of blood staining on the LMA cuff after removal was significantly lower in the TD group than in the D and I groups (6% vs. 22% and 24%; p = 0.044 and p = 0.025). The incidence of sore throat in the post-anesthesia care unit was significantly lower in the TD group than in the D and I groups (8% vs. 26% and 28%; p = 0.033 and p = 0.019). ConclusionThe modified tongue depressor-aided technique is superior to the digital manipulation and introducer tool techniques for ProSeal LMA insertion.

Awake insertion of proseal laryngeal mask airway: A technique for cases of fixed flexed neck deformity

Fixed flexion deformity of the neck due to postburn contracture results in the nonalignment of oral, pharyngeal, and laryngeal planes for intubations. Airway management is a challenge to anesthesiologist in these cases. Awake fiberoptic intubation if available is the gold standard in such cases. The design of ProSeal laryngeal mask airway (LMA) is such that it provides a good alternative to the endotracheal tube and its insertion does not require the visualization of the vocal cords. We present the successful airway management of a patient with severe fixed flexion deformity of the neck by an awake ProSeal LMA insertion.

A comparison of 3 ventilation strategies in children younger than 1 year using a Proseal laryngeal mask airway: a randomized controlled trial

Study ObjectiveTo determine quantitative differences in several routinely measured ventilation parameters using a standardized anesthetic technique and 3 different ventilation modalities in patients younger than 1 year with a ProSeal laryngeal mask airway (PLMA). DesignRandomized prospective study. SettingTertiary care pediatric hospital. PatientsThirty-nine American Society Anesthesiologists classifications 1 to 2, pediatric patients younger than 1 year. InterventionsThree different ventilation strategies (spontaneous ventilation [SV], pressure support ventilation [PSV], and pressure-controlled ventilation [PCV]) were randomly applied to patients who underwent a standardized mask induction with sevoflurane/oxygen and propofol 2 mg/kg and fentanyl 2 μg/kg administered intravenously followed by PLMA insertion. Patients were maintained on sevoflurane and N2O. MeasurementsWe measured the differences in end-tidal CO2 (etco2), tidal volume (TV), and respiratory rate (RR) over time between SV, PSV, and PCV. These data were recorded at 5-minute intervals. Main Resultsetco2 (mm Hg) was not significantly higher in the SV vs PSV (P=2.11) and SV vs PCV (P=.24). TV (mL/kg) was significantly lower in SV vs PSV (P<.005) and SV vs PCV (P<.005). RR was not significantly higher in SV vs PSV (P=.43), but was significantly higher in SV vs PCV (P<.005). Three patients in the SV group and 1 patient in the PSV group failed to initiate SV and required PCV and were thus excluded from analysis. ConclusionsAll 3 modes of ventilation using a PLMA were safe in children younger than 1 year. Although we did not observe a statistically significant increase in etco2, differences in TV and RR, and the small but significant incidence of apnea may make PSV or PCV more optimal ventilation strategies in children younger than 1 year when using a PLMA.

Comparing 3 ventilation modalities by measuring several respiratory parameters using the ProSeal laryngeal mask airway in children

Study objectiveTo determine quantitative differences in several routinely measured ventilation parameters using a standardized anesthetic technique and 3 different ventilation modalities in pediatric patients with a ProSeal laryngeal mask airway (PLMA). DesignRandomized prospective study. SettingPediatric hospital of a tertiary care academic medical center. PatientsThirty-three, American Society of Anesthesiologists classification 1-2, pediatric patients (12 months to 5 years). InterventionsThree different ventilation strategies: spontaneous ventilation (SV), pressure support ventilation (PSV), and pressure-controlled ventilation (PCV) were randomly applied to patients who underwent a standardized mask induction with sevoflurane/oxygen and propofol 3 mg/kg and morphine 0.05 mg/kg administered intravenously followed by PLMA insertion. Patients were maintained on sevoflurane and N2O. MeasurementsWe measured the differences in end-tidal CO2 (Etco2), tidal volume, and respiratory rate over time between SV, PSV, and PCV. These data were recorded at 5-minute intervals. Main resultsEtco2 (mm Hg) was significantly higher in the SV vs PSV (P=.016) and vs PCV (P<.001). Tidal volume (mL/kg) was significantly lower in SV vs PSV (P<.001) and vs PCV (P<.001). Respiratory rate (breaths/min) was significantly higher in SV vs PSV (P<.001) and vs PCV (P=.005). ConclusionsAll 3 modes of ventilation using a PLMA were safely used. Our SV group was noted to have a significantly higher Etco2 when compared with PSV and PCV with a mean Etco2 over time in excess of 55 mm Hg. PSV and PCV were found to be more appropriate ventilation strategies to more optimally control Etco2 over time in these patients.

Comparison of Dexmedetomidine-Propofol versus Fentanyl-Propofol on Insertion Conditions of Proseal Laryngeal Mask Airway.

Proseal Laryngeal Mask Airway (PLMA) is a newer supraglottic airway device that requires adequate depth of anaesthesia and suppression of upper airway reflexes thereby providing optimal insertion conditions. To compare dexmedetomidine and fentanyl for co-induction with propofol with respect to PLMA insertion conditions, haemodynamic variation and the total dose requirement of propofol. This was a prospective randomized double-blinded study conducted in 60 cases of American Society of Anaesthesiologists (ASA) class I/II undergoing elective surgery under general anaesthesia. They were randomly divided into two equal groups, D and F, each receiving 1μg/kg of dexmedetomidine and fentanyl respectively followed by Propofol 2.5mg/kg as per protocol. The ease of PLMA insertion was Young's Criteria and Modified scheme of Lund and Stovener. The haemodynamic parameters (mean heart rate, mean arterial pressure, Respiratory rate, SPO2) were monitored at: Baseline, Pre-medication, Pre PLMA, Post LMA (at insertion), 1, 3, 5, 10, 15 and 20 minutes. PLMA insertion conditions and haemodynamics were comparable between the dexmedetomidine-propofol and fentanyl-propofol groups according to the Young's criteria and Modified scheme of Lund and Stovener. Total induction dose of propofol and its increments were significantly reduced in the dexmedetomidine group. Dexmedetomidine and fentanyl when both used individually for co-induction with propofol for PLMA insertion give excellent overall insertion conditions with haemodynamic stability. Dexmedetomidine also significantly reduces the requirements of induction dose propofol for PLMA insertion.

Comparison of midazolam and dexmedetomidine as an adjuvant for proseal laryngeal mask airway insertion: A randomized control trial

Comparison of midazolam and dexmedetomidine as an adjuvant for proseal laryngeal mask airway insertion: A randomized control trial

Comparison of three insertion techniques of ProSeal laryngeal mask airway: A randomized clinical trial.

Background and Aims:We aimed to compare three techniques for insertion of ProSeal laryngeal mask airway (PLMA).Material and Methods:Two hundred ten patients (American Society of Anaethesiologists I-II, aged 18–60 years) undergoing general anesthesia using the PLMA as an airway management device were randomly allocated to digital (D), rotational (R), or pharyngoscopic (P) techniques. In the D group (n = 70), the PLMA insertion was performed by using digital manipulation. In the R group (n = 70), the PLMA was inserted into the mouth, rotated anticlockwise through 90° and advanced into the hypopharynx. In the P group (n = 70), the PLMA was inserted after gentle pharyngoscopy using laryngoscope. Success rate at the first attempt, insertion time, airway manipulations required, and postoperative complications were noted.Results:Insertion at first attempt was more successful with P technique than the R and D groups (100% vs. 98.5% vs. 81.4% respectively, P < 0.01). Insertion time was shortest for the P group which was statistically significant compared to the group D (P < 0.001), but comparable with the R group. None of the patients required manipulation in the P group compared to the group R (P = 0.04) and D (P < 0.001). Blood staining (group P = 2.8% vs. group R = 2.8% vs. group D = 22%, P < 0.0001) and sore throat (group P = 0% vs. group R = 6.9% vs. group D = 16.7%, both: P < 0.005) were lower with the pharyngoscopic technique.Conclusion:We conclude that the pharyngoscopic technique for PLMA insertion is more successful with lower incidence of complications (mucosal bleeding and sore throat).